GENERAL INFORMATION OF THE FAMILY:

Name of the head of the family- Mr.Suman ch Sarkar

House No- 17

Village/City- Bk Palli

House own/Rented - Own

Address- Narsingarh

Type of house- kaccha

Religion- Hinduism

No of rooms-3

Caste- SC

Ventilation- Well

Total monthly income of family- 20,000

Monthly per capita income- 5000

Socioeconomic status- Normal

Mother tongue – Bengali .

District-west Tripura

State-Tripura

Age-73 years

Sex- Male

2. INTRODUCTION:

a. General Information-

I went to the village of Narsingarh during my community posting. I visited homes during my
community posting and selected this family for providing care as the family members have
various health problems which is needed to be cares and I also gave them health educations
on various health remedies.

b. Family-

Type of family- My client have a nuclear type of family.

Number of members in the family- Number of family members are 5.

Mother tongue- Bengali

Religion- Hinduism

Customs and habits- Their custom is Hindu and my client is having bad habit like smoking,
father was having bad habit like alcoholism and mother is having bad habit like chewing
tobacco.

3. COMMUNITY ASSESSMENT-

a. Name of the taluk/district- West Tripura

b. population rate - Normal

c. Main caste group- Scheduled caste

d. Religion-Hinduism

e. Occupation- Agriculture

f. Method of recording births and deaths- Survey

g. Facilities available in the area and distance in km-

Medical: Types of hospital :-Narsinghar PHC

Means of communication-

a. Language of the family-

 Mother tongue- Bengali

 State- Tripura
 Nationality-Indian

b. Communication facilities available- Newspaper, Mobile, Postal system

Sanitation- They use sanitary latrines for defecation

Worship- They believe in all Hindu Gods and Goddesses

Transport- Bike, Auto rickshaw, Cycle are available.

Supplies-Foods, textiles and miscellaneous things and bought from shops.

Recreation- Recreation activity they play ludo and if any community gatherings wherever
organised in the area.
4. FAMILY ASSESSMENT-

a. Home and family-

I. Family set up-

Mr. Suman Sarkar Mrs.Minali Sarkar

Mr.Samjit Sarkar Mrs. Rekha Sarkar

Age -43 y Age-42 year

Mr Sujan Sarkar
Age- 24 year

Sl Name Relationshi Age Sex Education Occupatio Wages/ Healt

No p with head n Salary h
. of family Income Status
1. Mr. Head of the 73 Male Class v Business 10000 per COP
Suma family yea pass month D
n r
sarkar
2. Mrs. Wife 72 Femal Madhyami - - Good
Minali yea e k pass
Sarkar r
3. Mr. Son 43 Male B.SC Pass - Rs. 10000 Good
Samjit yea per month
sarkar r

4. Mrs. Daughter in 42 Femal XII pass - - Good

Rekha law yea e
Sarkar r

5. Mr. Grandson 24 Male B.SC Pass Business - Good

Sujan y
Sarkar
 II. Property and income in additional to salary/wages-
House: My client have kaccha house.
Income: 20,000
III. Family and social relationship:
They are maintain good IPR with family members along with society.
IV. Nutritional Status: Non-vegetarian.
a) Number of meals per day : They take meals 3 times a day
b) Eating pattern :
Breakfast – Rice, dal
Lunch- Rice, dal, egg
Evening-Tea, snacks
Dinner-Rice, dal, boiled potato
c) Selection and preparation- They prepare the food by themselves in chulli, firewood.
The foods they prepare are oily. They maintain hygiene while preparing food.

d) staple foods of the family- Rice, potatoes, mixed veg and fish.

v. Description of the house and surroundings:

a) Housing-

Built- Kacha house

Number of rooms in house- 3 rooms

Average size of rooms- 138 sq.ft

Ventilation- Adequate

Roof-Tin

Walls-Mud

Floors-Mud

Furniture- Table:1, chair : 3, Bed : 2

Source of light- Electricity

b) Water supply- They drink their drinking water from hand pump

c) Kitchen-

Place-Separate

Sources of fuel- Firewood

Kitchen garden-Available
Storage of food and water- Food is stored in the utensils and water stored in filter.

d) Disposal system-

Excreta-Household latrine

Refuse-Community refusal disposal system

vi. Family health attitudes, beliefs and practices with regards to-

e) Disease-They do not think the disease are punishments from Gods and think and
understands that these can be reduced or prevented by treating appropriately.

f) Food-They are non-vegetarian.

5. PHYSICAL ASSESSMENT:

a. Name – Mr. Suman Sarkar

Weight- 53 kg.

Height – 158 cm

Temperature – 99‫﮲‬c

Pulse- 72 beats/minute

Respiration- 18 breaths/minute

BP- 130/88 mm.hg

Skin- Client Skin complexion is dark, touch sensation is present, No rashes are found

Hair – Hair are dry & dehydrated

Eyes- Eyebrows- Normal

Eyelash- Present

Eye lid- Normal

Sclera- Sclera is whitish in color

Eye discharge- Not present

Ears- Client have no inflammation of structural problem in ear. The position of the both ears
are bilaterally symmetrical.
Nose- Client nostrils are bilaterally symmetrical normal in shape ,no discharge are present,
alfectory function is normal.

Mouth- Lips and tongue looks dehydrated and there is no inflammation present.

Neck-Range of motion – All the movements are possible(extension,Flexion,rotation).

Chest-

Shape – Chest is normal in shape

Chest movements- Expansion and relaxation are seen.

Respiration-18 breaths/minute

Cough-Absent

Sputum-Absent

Haemptysis- Not present

Breast-Normal

Inspection-No rashes, scar, swelling

Mass-Absent

Muscular -skeletal-Range of motion normal

Joints-No joint swelling is present

Genitals- The external structure of genitalia is normal, there is no infection, ulceration

present.

Needs/Problems Identified According To Priority-

Chief complaints-

1. Name- Mr. Suman Sarkar

Diagnosis- Chronic obstructive pulmonary disease

Health defects-

 Shortness of breathing
 Chest pain
 Fever
 Cough
 Weakness
Nursing Diagnosis- According to priority

1. Ineffective breathing pattern related to shortness of breath, tachypnoea as evidenced by

increase respiration.

2. Ineffective thermoregulation more than body temperature related to infection process as

evidenced by increase temperature , pulse and respiration.

3. Imbalanced nutrition less than body requirements related to anorexia as evidenced by lack
of interest to take food, fatigue and weakness.

4. Activity intolerance related to imbalance between oxygen and carbon-di-oxide supply as

evidenced by restless, tired.

5. Impaired gas exchange related to chronic pulmonary obstructive alveoli distraction as

evidenced by restless, change in heart rate.

6. Ineffective airway clearance related to upper airway as evidenced by tachypnoea.

7. Sleep pattern disturbance related to shortness of breathing as evidenced by restless and

tired.

8. Self care deficit related to bathing as evidenced by complaints of shortness of breathing.

9. Deficient knowledge related to prevention of COPD as evidenced by lots of questions from

the client .
THEORY APPLICATIONS-

In the care of the clients, I have chosen ‘Theory of Interpersonal relations’ given by Hildgard
E. Paplau.

Identified four sequential phases in the interpersonal relationship-

I. Orientation
II. Identification
III. Exploitation
IV. Resolution

Application of this theory to the care of the client-

In the care of the clients with Chronic Obstructive Pulmonary Disease and asthma in
the family. So I need to maintain a good interaction with the family members to
achieve the goal by working together so that both become mature and knowledgrable
in the process.
  Paplau Interpersonal Relationship Theory Model-

Nurse Orientation- Client Orientation-

Meet with the client, identify the client, asking The client gave self introduction & greet with me
the need of problems the family members are
facing.

Identification- Identification-

The client is suffering from COPD, by the The client is explain that he is suffering from
prescription we know. Shortness of breathing, chest pain.

Exploitation- Exploitation-

1.Carry out plans mutually agreed upon The client is follow my instruction.

2.Made the client to perform breathing exercise

3.Allow the family members to give

psychological support

Resolution phase-
Resolution phase-
Provide health education to the client
The client and family members to follow my
instruction in future
Disease condition

1. Introduction - Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory

lung disease that causes obstructed airflow from the lungs. Symptoms include breathing
difficulty, cough, mucus (sputum) production and wheezing. It's typically caused by long-
term exposure to irritating gases or particulate matter, most often from cigarette smoke.
People with COPD are at increased risk of developing heart disease, lung cancer and a variety
of other conditions.

Emphysema and chronic bronchitis are the two most common conditions that contribute to
COPD. These two conditions usually occur together and can vary in severity among
individuals with COPD.

2. Definition - Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory

lung disease that causes obstructed airflow from the lungs. Symptoms include breathing
difficulty, cough, mucus (sputum) production and wheezing.

Causes- COPD develops gradually over time, the causes are as follows-

Tobacco exposure – from active smoking or passive exposure to second-hand smoke,

Occupational exposure to dusts, fumes, or chemicals,

Indoor air pollution – biomass fuel (wood, animal dung, crop residue) or coal is frequently
used for cooking and heating in low- and middle-income countries with high levels of smoke
exposure,early life events such as poor growth in utero, prematurity, and frequent or severe
respiratory infections in childhood that prevent maximum lung growth, asthma in childhood;
and a rare genetic condition called alpha-1 antitrypsin deficiency, which can cause COPD at a
young age.

5. Risk factors- Smoking is the biggest risk factor for chronic obstructive pulmonary disease
(COPD), which includes chronic bronchitis and emphysema. It increases your risk of both
developing and dying from COPD. Approximately 85 to 90 percent of COPD cases are
caused by smoking. Female smokers are nearly 13 times as likely to die from COPD as
women who have never smoked; male smokers are nearly 12 times as likely to die from
COPD as men who have never smoked.

Other risk factors for COPD include:

 Exposure to air pollution

 Breathing second hand smoke
 Working with chemicals, dust and fumes
 A genetic condition called Alpha-1 deficiency
 Pathophysiology-
Cigarette smoke ATAT deficiency

Neutrophil activation + Macrophage activation

PROTEASE ACTIVATION

Destruction of elastase

( integral component in structure of alveoli)

Alveolar tissue damage

Chronic Obstructive Pulmonary Disease

Fig- COPD Pathophysiology

7)Symptoms -
 Shortness of breath, especially during physical activities.
 Wheezing.
 Chest tightness.
 A chronic cough that may produce mucus (sputum) that may be clear, white, yellow or
greenish.
 Frequent respiratory infections.
 Lack of energy.
 Wheezing .
 Unintended weight loss (in later stages) .

8) Diagnostic evaluation-
Chest X-ray-A chest X-ray can show emphysema, one of the main causes of COPD. An X-
ray can also rule out other lung problems or heart failure.

CT scan-A CT scan of your lungs can help detect emphysema and help determine if you
might benefit from surgery for COPD. CT scans can also be used to screen for lung cancer.
Arterial blood gas analysis-This blood test measures how well your lungs are bringing
oxygen into your blood and removing carbon dioxide.

Laboratory tests-Lab tests aren't used to diagnose COPD, but they may be used to determine
the cause of your symptoms or rule out other conditions.

Complications –
 Lung Infections
 Collasped Lung (Pneumothorax)
 Poor gas exchange
 Heart problems
 Atrial fibrillation
 Osteoporosis
 Weak arms and legs
 Weight issues
 Diabetes
 Sleep problems

Prevention -
The most common cause of COPD is cigarette smoking. Smoking accounts for eight out of
10 COPD-related deaths, according to the Centres for Disease Control and Prevention (CDC).
1) One of the best ways to prevent getting COPD is to never start smoking, or to quit
smoking if you already do. If you have trouble quitting smoking, there are numerous options
to help you, including gums, patches, and prescription medication. Additionally, support
groups and classes to help you quit smoking can often be found through hospitals,
workplaces, and community associations.

Here are some tips to reduce your exposure to COPD-causing irritants:

 If you have a wood-burning stove or fireplace, make sure it's well ventilated.
 Stay indoors if there's noticeable air pollution outside, such as smog or a nearby
wildfire.
 Make your home an environment free from second hand smoke.

Conclusion
As per my clinical posting I have posted in the Rural area – B.K Palli , Alanganagar
and I got a patient with COPD. I have given care as per need of the patient and it will
help me to deal with some kind of patient in future.